Attention all clinical folks: there’s a reason you always at least listen to the heart and lungs. (I previously thought this was just a cruel med student joke.)

Guy comes in, typical geriatric patient with multiple chronic diseases, and I notice that he’s huffing and puffing, walking about the 30 feet from the waiting room to the exam room. I comment about this, and he and his wife note that he’s had this over the past month, but never before. Curious.

We talk through the rest of the visit, talking about his memory problems (dementia), his recent falling 20-30 times per week, his getting-up-to-pee 5-6 times per night, his chronic 10/10 lower back pain, and then I do the physical exam. Rales (also known as crackles) on both sides of the bottoms of his lungs. Pitting edema in his ankles. Curious indeed.

So I’m presenting to the attending and fellow, and they’re blown away. “Wow! Great job! Good pickup!” So we order an echo, get an EKG in the clinic, and put in an urgent cardiology request.